Fraudulent Use of Credit or Debit card

Unauthorized use of your credit or debit card by an unknown person.

Someone unknown to you has stolen your credit or debit card number only and used it to make purchases or charges without your permission.  Please provide the 16-digit card number with the specific date, time and locations of the fraudulent charges.  You will be asked to provide a copy of your bank statement or the Dispute Form you file with your financial institution.

If this is a Supplemental report please provide the Original Report Number
If you are filing on behalf of a business.
MM/DD/YYYY
Please enter all the information that applies. If you do not know the address of the incident, use the nearest intersection such as Market St./ 10th St.
MM\DD\YYYY
HH:MM AM or PM

Please provide the following information for each fraudulent charge: The date, time, location/address, and dollar amount. Please provide the 16-digit card number, type of card, and name of the issuing bank. Please have a copy of your bank statement or the Dispute Form from your financial institution available to forward to Sheriff's Office by email or fax. You can also attach the documents to this form.

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